The overall rate of Tennesseans without health insurance increased slightly from 2017 to 2018, while the cohort of uninsured children saw a significant increase this year, according to an annual TennCare survey conducted by the University of Tennessee’s Boyd Center for Business and Economic Research.

Authored by accounting professor LeAnn Luna and research associate Emily Pratt, The Impact of TennCare: A Survey of Recipients, 2018 found the percentage of uninsured Tennesseans to be 6.7 percent, an increase of more than 40,000 Tennesseans compared to the 6.1 percent rate in 2017.

The report found the number of uninsured children to be around 34,458, an amount similar to the 36,104 uninsured children reported in 2014 — the year the Affordable Care Act took effect. The uninsured children rate increased from 1.5 percent in 2017 to 2.3 percent in 2018, Pratt and Luna’s report stated.

Commissioned by the Tennessee Department of Finance and Administration, the report represents a summary of findings from a telephone survey of approximately 5,000 Tennessee households between May and July. The Boyd Center has conducted the survey since 1993.

Although other states conduct their own reports using different methodologies, Luna said the increase of uninsured Tennesseans is consistent with broader national trends.

The report did note that the uninsured increase coincides with some administrative changes to the Affordable Care Act, like much-shorter enrollment periods. In 2018, the Centers for Medicare and Medicaid Services cut the open enrollment period for health insurance in half, from 92 days to 45 days.

Luna said significant cuts to the advertising budget for marketing the Affordable Care Act plans also coincided with the increase in uninsured. For 2019, CMS has allocated $10 million to advertise the plans, compared to $36 million in 2018 and $63 million in 2017.

In addition to determining uninsured rates, the survey collects information about the use of medical facilities, TennCare satisfaction levels and reasons for failing to obtain medical insurance.

“We want to know what the number of uninsured is, how it changes over time and what those trends are, but we also want to be able to give feedback to TennCare to let them know how their program is doing. So it can inform policy, as well as inform the agency about how they’re doing and how people feel about it,” Luna said.

Considering premium rates have increased annually by double digits the past four years, affordability was cited by 82 percent of respondents as their major reason for not obtaining health insurance. Just 8 percent cited affordability as a minor reason.

Even 77 percent of those who reported their household income as being “$40,000 and above” reported affordability as a major reason for not obtaining health insurance.

Until this year, the rate of respondents citing affordability as a major reason has slowly declined from 86 percent in 2014, 83 percent in 2015, 80 percent in 2016 and 78 percent in 2017.

For the second straight year, the percentage TennCare recipients “very satisfied” or “somewhat satisfied” with the quality of care received from the state’s Medicaid program reached 95 percent. For the past 10 years, satisfaction rates for TennCare have exceeded 90 percent.

“I am pleased that TennCare continues to be recognized for providing access to high quality care for our members,” TennCare Director Wendy Long said. “We collaborate with our health plans to promote the delivery of the right care in the right place at the right time, and those efforts are paying off.”

Other highlights from this year’s survey include:

• Approximately 75 percent of TennCare members obtained a doctor’s appointment within a week, and 47 percent obtained an appointment within one day, marking record highs for both measures. Only 11 percent reported waiting more than three weeks for an appointment, a record low.

• Ninety-two percent of all TennCare heads of household reported seeking care first at a doctor’s office or clinic instead of going to the emergency room, while 95 percent of heads of household statewide reported the same behavior.